CA2759937A1 - Method and apparatus for optimising an extracorporeal blood treatment - Google Patents
Method and apparatus for optimising an extracorporeal blood treatment Download PDFInfo
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- 238000011282 treatment Methods 0.000 title claims abstract description 179
- 239000008280 blood Substances 0.000 title claims abstract description 116
- 210000004369 blood Anatomy 0.000 title claims abstract description 116
- 238000000034 method Methods 0.000 title claims abstract description 26
- 239000012530 fluid Substances 0.000 claims description 63
- 230000017531 blood circulation Effects 0.000 claims description 53
- 238000000502 dialysis Methods 0.000 claims description 32
- 230000001225 therapeutic effect Effects 0.000 claims description 14
- 239000012528 membrane Substances 0.000 claims description 9
- 238000009826 distribution Methods 0.000 claims description 7
- 238000004590 computer program Methods 0.000 claims description 3
- 238000001631 haemodialysis Methods 0.000 description 13
- 239000000306 component Substances 0.000 description 7
- 238000002615 hemofiltration Methods 0.000 description 6
- 238000004364 calculation method Methods 0.000 description 5
- 239000000126 substance Substances 0.000 description 5
- BVKZGUZCCUSVTD-UHFFFAOYSA-M Bicarbonate Chemical class OC([O-])=O BVKZGUZCCUSVTD-UHFFFAOYSA-M 0.000 description 4
- XSQUKJJJFZCRTK-UHFFFAOYSA-N Urea Chemical compound NC(N)=O XSQUKJJJFZCRTK-UHFFFAOYSA-N 0.000 description 3
- 239000002253 acid Substances 0.000 description 3
- 239000004202 carbamide Substances 0.000 description 3
- 238000010790 dilution Methods 0.000 description 3
- 239000012895 dilution Substances 0.000 description 3
- 230000000694 effects Effects 0.000 description 3
- 230000005611 electricity Effects 0.000 description 3
- 239000012466 permeate Substances 0.000 description 3
- 230000001419 dependent effect Effects 0.000 description 2
- 238000009792 diffusion process Methods 0.000 description 2
- 238000005534 hematocrit Methods 0.000 description 2
- 210000002700 urine Anatomy 0.000 description 2
- 241001631457 Cannula Species 0.000 description 1
- 206010052804 Drug tolerance Diseases 0.000 description 1
- 230000036770 blood supply Effects 0.000 description 1
- 208000020832 chronic kidney disease Diseases 0.000 description 1
- 208000022831 chronic renal failure syndrome Diseases 0.000 description 1
- 238000004140 cleaning Methods 0.000 description 1
- 230000006870 function Effects 0.000 description 1
- 238000002360 preparation method Methods 0.000 description 1
- 238000006467 substitution reaction Methods 0.000 description 1
- SRYYCRXKYKWXDQ-PTGKCMAJSA-N success Chemical compound O([C@H]1CCC[C@@H](OC(=O)C[C@H]2[C@@H]3C=C[C@@H]4C[C@H](C[C@H]4[C@@H]3C=C2C(=O)[C@@H]1C)O[C@H]1[C@@H]([C@H](OC)[C@@H](OC)[C@H](C)C1)OC)CC)[C@H]1CC[C@H](N(C)C)[C@@H](C)O1 SRYYCRXKYKWXDQ-PTGKCMAJSA-N 0.000 description 1
- 238000002560 therapeutic procedure Methods 0.000 description 1
- 238000000108 ultra-filtration Methods 0.000 description 1
- 230000002792 vascular Effects 0.000 description 1
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 1
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
- A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
- A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes
- A61M1/1601—Control or regulation
- A61M1/1613—Profiling or modelling of patient or predicted treatment evolution or outcome
-
- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q10/00—Administration; Management
- G06Q10/10—Office automation; Time management
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q50/00—Information and communication technology [ICT] specially adapted for implementation of business processes of specific business sectors, e.g. utilities or tourism
- G06Q50/10—Services
- G06Q50/22—Social work or social welfare, e.g. community support activities or counselling services
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
- G16H20/40—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2205/00—General characteristics of the apparatus
- A61M2205/50—General characteristics of the apparatus with microprocessors or computers
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Abstract
A method and an apparatus for selecting a dialyzer or filter from cost standpoints for an extracorporeal blood treatment using an extracorporeal blood treatment apparatus are disclosed. In the method and apparatus at least one machine-specific treatment parameter for carrying out the treatment using the respective dialyzer or filter is determined with a computing unit for different types of dialyzers or filters. The computing unit allows determining the costs resulting from the determined machine-specific treatment parameters when using the respective dialyzer or filter. The determined costs for all types of dialyzers or filters are then displayed on a display unit. In this way, the information required for selecting the dialyzer or filter is provided to the treating doctor. The doctor can then select the dialyzer or filter in order to keep the costs of the blood treatment as low as possible.
Description
Method and apparatus for optimising an extracorporeal blood treatment The invention relates to a method and a device for optimising an extracorporeal blood treatment with an extracorporeal blood treatment apparatus, which comprises a dialyser or filter divided by a semipermeable membrane into a first chamber and a second chamber, wherein the first chamber is part of an extracorporeal blood circuit and the second chamber of the dialyser or filter is part of a dialysing fluid system. Moreover, the invention relates to an extracorporeal blood treatment apparatus with a device for optimising the extracorpo-real blood treatment. The invention also relates to a computer program product to be run on a data processing device for performing a method for optimising the extracorporeal blood treatment.
Various methods for extracorporeal blood treatment or cleaning are used in chronic kidney failure in order to remove substances usually eliminated with urine and for fluid with-drawal. In haemodialysis, the patient's blood is cleaned outside the body in a dialyser.
The dialyser comprises a blood chamber and a dialysing fluid chamber, which are sepa-rated by a semipermeable membrane. During the treatment, the patient's blood flows through the blood chamber, whilst dialysing fluid flows through the dialysing fluid cham-ber in order to free the patient's blood from substances usually eliminated with urine.
Whereas the transport of the low-molecular substances through the membrane of the dia-lyser is essentially determined by the concentration differences (diffusion) between the dialysing fluid and the blood in the case of haemodialysis (HD), substances dissolved in the plasma water, in particular higher-molecular substances, are effectively removed by a high fluid flow (convection) through the membrane of the dialyser in the case of haemofil-tration (HF). In haemofiltration, the dialyser functions as a filter.
Haemodiafiltration (HDF) is a combination of the two processes.
Various methods for extracorporeal blood treatment or cleaning are used in chronic kidney failure in order to remove substances usually eliminated with urine and for fluid with-drawal. In haemodialysis, the patient's blood is cleaned outside the body in a dialyser.
The dialyser comprises a blood chamber and a dialysing fluid chamber, which are sepa-rated by a semipermeable membrane. During the treatment, the patient's blood flows through the blood chamber, whilst dialysing fluid flows through the dialysing fluid cham-ber in order to free the patient's blood from substances usually eliminated with urine.
Whereas the transport of the low-molecular substances through the membrane of the dia-lyser is essentially determined by the concentration differences (diffusion) between the dialysing fluid and the blood in the case of haemodialysis (HD), substances dissolved in the plasma water, in particular higher-molecular substances, are effectively removed by a high fluid flow (convection) through the membrane of the dialyser in the case of haemofil-tration (HF). In haemofiltration, the dialyser functions as a filter.
Haemodiafiltration (HDF) is a combination of the two processes.
2 Various dialysers or filters are known for performing extracorporeal blood treatments. The known dialysers or filters include the so-called high-flux and low-flux dialysers or filters.
High-flux dialysers are characterised by a higher ultrafiltration coefficient than low-flux dialysers For an extracorporeal blood treatment, the doctor in charge must preselect a number of treatment parameters which on the one hand relate to the patient and on the other hand to the blood treatment apparatus used to perform the blood treatment. The treatment parame-ters to be preselected by the doctor are therefore referred to below as patient-specific or machine-specific treatment parameters.
In the following, patient-specific treatment parameters are understood to mean the parame-ters which are characteristic of the therapeutic aim and/or the patient to be treated. The doctor in charge first selects the respective therapeutic method for the patient, a distinction having to be made for example between haemodialysis (HD), haemofiltration (HF) and haemodiafiltration (HDF). Furthermore, the doctor establishes treatment time t, taking account of the individual patient's circulatory stability. Furthermore, the doctor establishes dialysis dose ktN as the target value for the treatment. A value for dialysis dose kt/V of 1.4 generally applies as the target value for a suitable treatment. The literature also dis-cusses higher target values for women or particularly light patients. A
further patient-specific treatment parameter is the flow of blood in the extracorporeal circuit. The blood flow can be varied by the doctor within certain limits during the treatment, but ultimately the adjustable blood flow is dependent on the nature and the properties of the patient's vas-cular access.
In the following, the machine-specific treatment parameters are understood to mean the parameters which the doctor himself can freely select for the performance of the extracor-poreal treatment, taking account of the patient-specific treatment parameters.
The ma-chine-specific treatment parameters include in particular the dialysing fluid flow rate, which can be set freely within certain limits with the known extracorporeal blood treat-ment apparatuses.
Since the doctor in charge has various types of dialyser or filter available to him for the performance of the extracorporeal blood treatment, which include for example the afore-
High-flux dialysers are characterised by a higher ultrafiltration coefficient than low-flux dialysers For an extracorporeal blood treatment, the doctor in charge must preselect a number of treatment parameters which on the one hand relate to the patient and on the other hand to the blood treatment apparatus used to perform the blood treatment. The treatment parame-ters to be preselected by the doctor are therefore referred to below as patient-specific or machine-specific treatment parameters.
In the following, patient-specific treatment parameters are understood to mean the parame-ters which are characteristic of the therapeutic aim and/or the patient to be treated. The doctor in charge first selects the respective therapeutic method for the patient, a distinction having to be made for example between haemodialysis (HD), haemofiltration (HF) and haemodiafiltration (HDF). Furthermore, the doctor establishes treatment time t, taking account of the individual patient's circulatory stability. Furthermore, the doctor establishes dialysis dose ktN as the target value for the treatment. A value for dialysis dose kt/V of 1.4 generally applies as the target value for a suitable treatment. The literature also dis-cusses higher target values for women or particularly light patients. A
further patient-specific treatment parameter is the flow of blood in the extracorporeal circuit. The blood flow can be varied by the doctor within certain limits during the treatment, but ultimately the adjustable blood flow is dependent on the nature and the properties of the patient's vas-cular access.
In the following, the machine-specific treatment parameters are understood to mean the parameters which the doctor himself can freely select for the performance of the extracor-poreal treatment, taking account of the patient-specific treatment parameters.
The ma-chine-specific treatment parameters include in particular the dialysing fluid flow rate, which can be set freely within certain limits with the known extracorporeal blood treat-ment apparatuses.
Since the doctor in charge has various types of dialyser or filter available to him for the performance of the extracorporeal blood treatment, which include for example the afore-
3 mentioned high-flux and low-flux dialysers, the doctor must select a specific dialyser or filter before the treatment. The selection of a particular type of dialyser, however, in turn affects the machine-specific treatment parameters which the doctor must set in order to achieve the therapeutic aim. With an unchanged blood flow, the same clearance can be achieved with a dialyser characterised by a greater effective surface with a smaller dialys-ing fluid flow rate as with a dialyser characterised by a smaller effective surface.
The doctor in charge will select the patient- and machine-specific treatment parameters in such a way that the blood treatment can be carried out in the optimum manner for the given patient. When the doctor in charge has different types of dialyser or filter available to him, however, there may be different parameters with which the blood treatment can be carried out in the optimum manner.
The problem underlying the invention is to provide a method for optimising an extracorpo-real blood treatment with an extracorporeal blood treatment apparatus, which makes it eas-ier for the doctor in charge to select the respective dialyser or filter from a group of dialys-ers or filters. Moreover, it is an object of the invention to provide a device for optimising an extracorporeal blood treatment, which makes it easier for the doctor to select the dia-lyser or filter. A further object of the invention is to make available an extracorporeal blood treatment apparatus with a device for optimising the extracorporeal blood treatment and a computer program product to be run on a data processing device for performing the method for optimising the extracorporeal blood treatment.
According to the invention, the objects are achieved with the features of claims 1, 7, 13 and 14. Preferred embodiments of the invention are the subject-matter of the sub-claims.
The method according to the invention and the device according to the invention for opti-mising an extracorporeal blood treatment are based on the fact that at least one machine-specific treatment parameter for performing the treatment using the given dialyser or filter is determined with a computing unit for different types of dialyser or filter, and the costs resulting from the ascertained machine-specific treatment parameter using the given dia-lyser or filter are determined with the computing unit, and the ascertained costs for all the types of dialyser or filter are displayed on a display unit. The information required for the selection to be made for the dialyser or filter is thus made available to the doctor in charge.
The doctor in charge will select the patient- and machine-specific treatment parameters in such a way that the blood treatment can be carried out in the optimum manner for the given patient. When the doctor in charge has different types of dialyser or filter available to him, however, there may be different parameters with which the blood treatment can be carried out in the optimum manner.
The problem underlying the invention is to provide a method for optimising an extracorpo-real blood treatment with an extracorporeal blood treatment apparatus, which makes it eas-ier for the doctor in charge to select the respective dialyser or filter from a group of dialys-ers or filters. Moreover, it is an object of the invention to provide a device for optimising an extracorporeal blood treatment, which makes it easier for the doctor to select the dia-lyser or filter. A further object of the invention is to make available an extracorporeal blood treatment apparatus with a device for optimising the extracorporeal blood treatment and a computer program product to be run on a data processing device for performing the method for optimising the extracorporeal blood treatment.
According to the invention, the objects are achieved with the features of claims 1, 7, 13 and 14. Preferred embodiments of the invention are the subject-matter of the sub-claims.
The method according to the invention and the device according to the invention for opti-mising an extracorporeal blood treatment are based on the fact that at least one machine-specific treatment parameter for performing the treatment using the given dialyser or filter is determined with a computing unit for different types of dialyser or filter, and the costs resulting from the ascertained machine-specific treatment parameter using the given dia-lyser or filter are determined with the computing unit, and the ascertained costs for all the types of dialyser or filter are displayed on a display unit. The information required for the selection to be made for the dialyser or filter is thus made available to the doctor in charge.
4 The doctor can then select the dialyser or filter in such a way that the cost of the blood treatment is as low as possible.
The device according to the invention for optimising the extracorporeal blood treatment can form a separate module which is operated alongside the extracorporeal blood treatment apparatus. The device according to the invention for the optimisation comprises an input unit for inputting the patient- and machine-specific treatment parameters and a computing unit as well as a display unit for displaying the costs resulting for the extracorporeal blood treatment. It is however also possible for the device according to the invention to be a component of an extracorporeal blood treatment apparatus. If the device according to the invention is a component of an extracorporeal blood treatment apparatus, the device ac-cording to the invention can make use of the input unit, display unit and/or computing unit of the extracorporeal blood treatment apparatus.
In a preferred embodiment of the invention, the machine-specific treatment parameter, which is determined for the different types of dialyser or filter, is the dialysing fluid flow, which the doctor in charge sets for the performance of the blood treatment. In principle, however, machine-specific treatment parameters other than the extracorporeal blood now can also be determined for all types of dialyser or filter.
In order to determine the cost of the extracorporeal blood treatment for all types of dialyser or filter, the method according to the invention and the device according to the invention preferably make provision to store in a memory unit the costs for the various types of dia-lyser or filter and the costs for the consumables and/or the energy costs. The various costs can preferably be inputted on the input unit and then read into the memory unit, so that the costs can be changed at any time. Both the costs of the consumables and the energy costs are preferably taken into account in the ascertainment of costs. It is however also possible to take account solely of the costs of the consumables or the energy costs.
The method according to the invention and the device according to the invention prefera-bly make provision to calculate with a computing unit the quantity of the respective con-sumables and/or the quantity of energy that is consumed in the performance of the extra-corporeal blood treatment with the ascertained machine-specific treatment parameter.
From the costs of the consumables and/or energy costs on the one hand and the calculated quantity of consumables and/or energy on the other hand, a calculation is made in the computing unit of the costs of the consumables and/or energy consumed in the extracorpo-real blood treatment. The computing unit also calculates, for all types of dialyser or filter, the total cost in each case from the sum of the stored cost of the respective dialyser or filter and the calculated costs of the consumables and/or energy consumed in the blood treat-ment.
A further preferred embodiment makes provision such that the display unit displays the different amounts of the machine-specific treatment parameter for the different dialysers or filters together with the total cost of the extracorporeal blood treatment resulting from the use of the given dialyser or filter and the adjustment of the given machine-specific treat-ment parameter, so that the doctor in charge can make a choice between the various dia-lysers or filters, taking account of the overall cost of the treatment. The overall cost is preferably broken down on the display unit into the costs resulting from the dialyser or filter, the consumables and the consumed energy.
An example of embodiment of the invention is explained in greater detail below by refer-ence to the drawings.
In the figures:
Fig. I shows the main components of an extracorporeal blood treatment apparatus together with a device for optimising the blood treatment in a very simpli-fied schematic representation, Fig. 2 shows the display unit of the device for optimising the blood treatment, wherein the display unit displays the dialyser or filter with which the total cost of the treatment is minimal, Fig. 3 shows the display unit of the device for optimising the blood treatment, wherein the costs are displayed for the blood treatment with a first blood flow rate for different types of dialyser or filter, Fig. 4 shows the display unit, on which the costs of the blood treatment are dis-played for a blood treatment with a second blood flow rate which is greater than the first blood flow rate, for the various types of dialyser or filter, Fig. 5 shows the display unit with the preselection of different treatment parame-ters, the display unit displaying the dialyser or filter with which the cost of the blood treatment is minimal, Fig. 6 shows the display unit of fig. 5, the costs being displayed for the blood treatment with a first blood flow rate for various types of dialyser or filter and Fig. 7 shows the display unit of fig. 5, on which the costs of the blood treatment are displayed for a blood treatment with a second blood flow rate which is greater than the first blood flow rate, for the various types of dialyser or fil-ter, Fig. 8 shows the display unit, wherein the therapeutic aim is not achieved, Fig. 9 shows the display unit after an optimisation step for which the unachieved therapeutic aim is stipulated as the target value, Fig. 10 shows the display unit, wherein the therapeutic aim is achieved with an in-crease in the blood flow rate, and Fig. 11 shows the display unit, wherein the therapeutic aim is achieved with an in-crease in the blood flow rate and the treatment time.
Fig. 1 shows in a very simplified schematic representation the components of an extracor-poreal blood treatment apparatus which are relevant to the invention and which can be operated both as a haemodialysis apparatus and/or a haemofiltration apparatus.
The extra-corporeal blood treatment apparatus will therefore be referred to in the following as a haemodiafiltration apparatus. The haemodiafiltration apparatus comprises a dialyser or filter 1, which is separated by a semipermeable membrane 2 into a blood chamber 3 and a dialysing fluid chamber 4. Inlet 3a of the blood chamber is connected to one end of an arterial blood supply line 5, into which a blood pump 6 is incorporated, whilst outlet 3b of the blood chamber is connected to one end of a venous blood return line 7, into which a drip chamber 8 is incorporated. Arterial and venous cannulas (not shown) for connection to the patient are present at the other ends of arterial and venous blood line
The device according to the invention for optimising the extracorporeal blood treatment can form a separate module which is operated alongside the extracorporeal blood treatment apparatus. The device according to the invention for the optimisation comprises an input unit for inputting the patient- and machine-specific treatment parameters and a computing unit as well as a display unit for displaying the costs resulting for the extracorporeal blood treatment. It is however also possible for the device according to the invention to be a component of an extracorporeal blood treatment apparatus. If the device according to the invention is a component of an extracorporeal blood treatment apparatus, the device ac-cording to the invention can make use of the input unit, display unit and/or computing unit of the extracorporeal blood treatment apparatus.
In a preferred embodiment of the invention, the machine-specific treatment parameter, which is determined for the different types of dialyser or filter, is the dialysing fluid flow, which the doctor in charge sets for the performance of the blood treatment. In principle, however, machine-specific treatment parameters other than the extracorporeal blood now can also be determined for all types of dialyser or filter.
In order to determine the cost of the extracorporeal blood treatment for all types of dialyser or filter, the method according to the invention and the device according to the invention preferably make provision to store in a memory unit the costs for the various types of dia-lyser or filter and the costs for the consumables and/or the energy costs. The various costs can preferably be inputted on the input unit and then read into the memory unit, so that the costs can be changed at any time. Both the costs of the consumables and the energy costs are preferably taken into account in the ascertainment of costs. It is however also possible to take account solely of the costs of the consumables or the energy costs.
The method according to the invention and the device according to the invention prefera-bly make provision to calculate with a computing unit the quantity of the respective con-sumables and/or the quantity of energy that is consumed in the performance of the extra-corporeal blood treatment with the ascertained machine-specific treatment parameter.
From the costs of the consumables and/or energy costs on the one hand and the calculated quantity of consumables and/or energy on the other hand, a calculation is made in the computing unit of the costs of the consumables and/or energy consumed in the extracorpo-real blood treatment. The computing unit also calculates, for all types of dialyser or filter, the total cost in each case from the sum of the stored cost of the respective dialyser or filter and the calculated costs of the consumables and/or energy consumed in the blood treat-ment.
A further preferred embodiment makes provision such that the display unit displays the different amounts of the machine-specific treatment parameter for the different dialysers or filters together with the total cost of the extracorporeal blood treatment resulting from the use of the given dialyser or filter and the adjustment of the given machine-specific treat-ment parameter, so that the doctor in charge can make a choice between the various dia-lysers or filters, taking account of the overall cost of the treatment. The overall cost is preferably broken down on the display unit into the costs resulting from the dialyser or filter, the consumables and the consumed energy.
An example of embodiment of the invention is explained in greater detail below by refer-ence to the drawings.
In the figures:
Fig. I shows the main components of an extracorporeal blood treatment apparatus together with a device for optimising the blood treatment in a very simpli-fied schematic representation, Fig. 2 shows the display unit of the device for optimising the blood treatment, wherein the display unit displays the dialyser or filter with which the total cost of the treatment is minimal, Fig. 3 shows the display unit of the device for optimising the blood treatment, wherein the costs are displayed for the blood treatment with a first blood flow rate for different types of dialyser or filter, Fig. 4 shows the display unit, on which the costs of the blood treatment are dis-played for a blood treatment with a second blood flow rate which is greater than the first blood flow rate, for the various types of dialyser or filter, Fig. 5 shows the display unit with the preselection of different treatment parame-ters, the display unit displaying the dialyser or filter with which the cost of the blood treatment is minimal, Fig. 6 shows the display unit of fig. 5, the costs being displayed for the blood treatment with a first blood flow rate for various types of dialyser or filter and Fig. 7 shows the display unit of fig. 5, on which the costs of the blood treatment are displayed for a blood treatment with a second blood flow rate which is greater than the first blood flow rate, for the various types of dialyser or fil-ter, Fig. 8 shows the display unit, wherein the therapeutic aim is not achieved, Fig. 9 shows the display unit after an optimisation step for which the unachieved therapeutic aim is stipulated as the target value, Fig. 10 shows the display unit, wherein the therapeutic aim is achieved with an in-crease in the blood flow rate, and Fig. 11 shows the display unit, wherein the therapeutic aim is achieved with an in-crease in the blood flow rate and the treatment time.
Fig. 1 shows in a very simplified schematic representation the components of an extracor-poreal blood treatment apparatus which are relevant to the invention and which can be operated both as a haemodialysis apparatus and/or a haemofiltration apparatus.
The extra-corporeal blood treatment apparatus will therefore be referred to in the following as a haemodiafiltration apparatus. The haemodiafiltration apparatus comprises a dialyser or filter 1, which is separated by a semipermeable membrane 2 into a blood chamber 3 and a dialysing fluid chamber 4. Inlet 3a of the blood chamber is connected to one end of an arterial blood supply line 5, into which a blood pump 6 is incorporated, whilst outlet 3b of the blood chamber is connected to one end of a venous blood return line 7, into which a drip chamber 8 is incorporated. Arterial and venous cannulas (not shown) for connection to the patient are present at the other ends of arterial and venous blood line
5, 7. This part of the fluid system represents extracorporeal blood circuit I of the haemodiafiltration appa-ratus.
Dialysing fluid system II of the haemodiafiltration apparatus comprises a device 9 for the preparation of fresh dialysing fluid, which is connected via a dialysing fluid supply line 10 to inlet 4a of dialysing fluid chamber 4 of dialyser 1 or filter. Leading away from outlet 4b of dialysing fluid chamber 4 of dialyser 1 or filter is a dialysing fluid return line 11, which leads to a drain 12. A dialysing fluid pump 13, which is disposed in dialysing fluid return line 11, is used to convey the dialysing fluid.
Furthermore, the haemodiafiltration apparatus comprises a substituate source 14, from which a substituate line 15, into which a substituate pump 16 is incorporated, leads to ve-nous drip chamber 8. A predetermined quantity of substitution fluid can be fed from sub-stituate source 14 to extracorporeal blood circuit I by means of substituate pump 16 when fluid is removed from the blood circuit via dialyser 1.
The haemodiafiltration apparatus further comprises a control and computing unit 17, which is connected via control lines 18, 19, 20 to blood pump 6, dialysing fluid pump 13 and substituate pump 16. Central control and computing unit 17 controls pumps
Dialysing fluid system II of the haemodiafiltration apparatus comprises a device 9 for the preparation of fresh dialysing fluid, which is connected via a dialysing fluid supply line 10 to inlet 4a of dialysing fluid chamber 4 of dialyser 1 or filter. Leading away from outlet 4b of dialysing fluid chamber 4 of dialyser 1 or filter is a dialysing fluid return line 11, which leads to a drain 12. A dialysing fluid pump 13, which is disposed in dialysing fluid return line 11, is used to convey the dialysing fluid.
Furthermore, the haemodiafiltration apparatus comprises a substituate source 14, from which a substituate line 15, into which a substituate pump 16 is incorporated, leads to ve-nous drip chamber 8. A predetermined quantity of substitution fluid can be fed from sub-stituate source 14 to extracorporeal blood circuit I by means of substituate pump 16 when fluid is removed from the blood circuit via dialyser 1.
The haemodiafiltration apparatus further comprises a control and computing unit 17, which is connected via control lines 18, 19, 20 to blood pump 6, dialysing fluid pump 13 and substituate pump 16. Central control and computing unit 17 controls pumps
6, 13 and 16 in such a way that a specific blood flow rate Qb is adjusted in extracorporeal blood cir-cuit I and a specific dialysing fluid rate Qd is adjusted in the dialysing fluid system II. The control and computing unit also preselects a specific substituate rate and adjusts the ul-trafiltration rate with which fluid is removed from the patient. The individual treatment parameter with which the extracorporeal blood treatment is to be carried out can be input-ted by the doctor in charge on an input unit (not shown).
The device according to the invention for optimising the blood treatment, which can form an independent unit or be a component of the extracorporeal blood treatment apparatus, will be described below. When the device for optimising the blood treatment is a compo-nent of the blood treatment apparatus, the device for optimising the blood treatment can make use of the components which are already present in the blood treatment apparatus.
For example, the device for optimising the blood treatment can make use of central com-puting and memory unit 17.
In the present example of embodiment, device 24 for optimising the blood treatment com-prises its own computing unit 24A, its own memory unit 24B and a separate input unit 24C
and separate display unit 24D, which are connected to one another via data lines 24E. De-vice 24 is connected via a further data line 23 to central computing and control unit 17.
Computing and memory unit 24A, 24B can form part of a central data processing system on which a data processing program runs, wherein input unit 24C can be a keyboard and display unit 24D a display screen.
Fig. 2 shows display screen 24D of the device according to the invention. The display screen displays the treatment parameters which are inputted by the doctor in charge on input unit 24C or which are calculated by computing unit 24A. The parameters are dis-played on the display screen with the aid of masks 25.
In the present example of embodiment, the doctor in charge first preselects the patient-specific treatment parameters which are characteristic of the therapeutic aim and the pa-tient to be treated. The treatment parameters characteristic of the therapeutic aim are dis-played on the display screen in input mask 25 in first line 25A, whilst the parameters char-acteristic of the patient are displayed in line 25B. The therapeutic aim is preselected by the doctor with the treatment parameters of dialysis dose Kt/V, treatment duration T and the treatment method: haemodialysis HD, haemodiafiltration HDF with post-dilution HDFPOSt or pre-dilution HDFpre. The doctor preselects for the patient a specific blood flow Qb, a specific urea distribution volume V and various other laboratory data, which can include for example haematocrit HKT. A tolerated deviation from the target value can be prese-lected for dialysis dose KtN.
In the present example of embodiment, 1.4 is preselected for dialysis dose Kt/V, 240 min for treatment time T, haemodialysis HD for the treatment method, 290 ml/min for blood flow Qb and 35 I for urea distribution volume V. Furthermore, 2% is preselected as the tolerated deviation from the target value for dialysis dose Kt/V.
Furthermore, the doctor can preselect whether high-flux dialysers or filters or low-flux dialysers or filters should preferably be used. The doctor can also preselect the type of blood treatment apparatus. This is set in column 25C of mask 25. Here, the doctor has preselected high-flux dialysers or filters and selected a dialysis machine of type 5008, which can be displayed by colour background of the individual fields. In order to prompt the doctor to consider an increase in the blood flow, a further value for the blood flow can be inputted which is greater than the first value. The subsequent calculation then takes place for the lower and the higher blood flow. Here, the doctor has inputted 320 ml/min for increased blood flow Qb. Both blood flows are displayed in column 25D.
Since an increase in the dialysing fluid flow above a preselected upper threshold value does not lead in practice to a significant increase in clearance K, an upper threshold value can be preselected for the dialysing fluid flow. In the case of patients with a small distri-bution volume V, it may happen that the target value for dialysis dose Kt/V is already rea-ched with a dialysing fluid flow that is smaller than the blood flow. In such cases, a dial-ysing fluid flow can be preselected that is equal to the blood flow. A
preselected lower threshold value can also be preselected for the dialysing fluid flow. The preselection of upper and lower threshold values for the dialysing fluid flow or blood flow is however only an option.
Device 24 according to the invention for optimising the blood treatment now determines, both for the preselected lower blood flow and the higher blood flow of 290 and ml/min respectively, the type of dialyser or filter with which the cost of the dialysis treat-ment is minimal with a specific dialysing fluid flow Qd. In the present example of em-bodiment, the device suggests, for optimisation of the blood treatment, a filter of type FX
100 with a dialysing fluid flow Qd of 500 ml/min when blood flow Qb is 290 ml/min.
When blood flow Qb is 320 ml/min, the device also suggests a filter of type FX
100, dial-ysing fluid flow Qd however being 400 ml/min. The way in which the data are evaluated is described in detail below.
In memory unit 24B, a specific blood flow range Qbl to Qb2 is assigned in each case to different dialysers or filters from a group of dialysers or filters. The group of dialysers or filters comprises two kinds of filters, which include the high-flux filters and the low-flux filters. The high-flux filters for example include the type series FX 50, FX
60, FX 80 and FX 100.
On the basis of the type of dialyser or filter selected by the doctor, for example a high-flux filter, and desired blood flow Qb, those filters are selected from the respective type series that are in principle suitable for desired blood flow Qb.
Example 1: Selected FX high-flux, Qb = 220 ml/min : FX 50 to FX 100 are possible.
Example 2: Selected FX high-flux, Qb = 370 ml/min : FX 60 to FX 100 are possible.
From the preselected value for dialysis dose KTN, for example 1.40, inputted treatment time T and inputted urea distribution volume V, computing unit 24A next calculates a tar-get value for clearance K. When the target value for clearance K is calculated, the prese-lected tolerance, for example 2%, is taken into account in the preselected target value for dialysis dose KTN, so that a value for dialysis dose KT/V within the preselected tolerance can be accepted in the subsequent calculation of the cost of the treatment. In individual cases, cost savings can thus be made without this having demonstrable effects on the suc-cess of the treatment in practice.
When the target value for clearance K is determined, computing unit 24A
calculates, for all the dialysers or filters that have been determined beforehand, dialysing fluid flow Qd required in each case for the treatment, taking account of the preselected treatment method, for example HD, HDFP0St, HDFpie, preselected blood flow Qb and other parameters, which include for example haematocrit HKT. From previously determined clearance K
and pre-selected blood flow Qb, the computing unit calculates dialysing fluid flow Qd that is re-quired to achieve desired clearance K. The calculation of required dialysing fluid flow Qd is carried out for an HD treatment with coefficient kOA on the basis of the following equa-tion:
1-exp -kOAQd -Qb K=QbQd Qd Qb eR kOA Qd - Qb Qd - Qb p Qd Qb For other types of treatment, such as for example HDF, other equations can be used to cal-culate K. Coefficient kOA is a magnitude characteristic of the given dialyser or filter, which is essentially dependent on the active surface of the semipermeable membrane of the dialyser or filter and its diffusion resistance.
Stored in memory unit 24B for all dialysers or filters are the respective coefficients kOA, which are read out from the memory by computing unit 24A in order to calculate dialysing fluid rate Qd. The aforementioned method for determining the dialysing fluid rate is de-scribed in detail in WO 2007/140993 Al, to the disclosure whereof reference is expressly made. For the invention, however, the method by which the dialysing fluid rate is deter-mined is ultimately irrelevant.
Furthermore, the costs of various consumables and the energy costs are stored in memory unit 24B. All the necessary costs (selling prices) can be inputted using appropriate menus.
In the present example of embodiment, the costs of the consumables include the costs for permeate, acid and bicarbonate and the energy costs include the costs for electricity. The costs (selling prices) of the individual dialysers or filters are also stored in memory unit 24B.
For all the dialysers or filters which are suggested for the blood treatment, computing unit 24B calculates the quantity of the given consumables (permeate, acid, bicarbonate) and the quantity of energy (electricity) that is consumed in the blood treatment, taking account of given dialysing fluid rates Qd and preselected blood flow rates Qb.
From the calculated quantity of consumables and the stored costs of consumables as well as the consumed energy and the energy costs, computing unit 24A now calculates the costs for all the consumables and the costs for the energy consumed in the treatment. Finally, the computing unit calculates the total costs for all types of dialysers or filters in each case from the sum of the previously determined costs for the consumables consumed in the treatment and the costs for the consumed energy as well as the costs of the dialysers or filters.
The final selection of the dialyser or filter is then made on the premise that the total cost is minimal.
Via the menu item "costs", the doctor can call up a sub-menu in which the individual costs for the suggested dialysers or filters are shown. Fig. 3 shows the sub-menu for the present example of embodiment, in which blood flow Qb of 290 ml/min (Qb 1) is preselected (fig.
2).
In the cost presentation, all the dialysers or filters which are suitable for the intended blood flow are always displayed in columns. In the present example of embodiment, in which a blood flow of 290 ml/min is preselected, these are the high-flux dialysers FX
50 to FX
100. A colour background of the menu items is used to identify those dialysers or filters with which the target value for dialysis dose KtN cannot be achieved, with which the tar-get value for the dialysis dose can only be achieved with a relatively high dialysing fluid flow or with a relatively low dialysing fluid flow. In the present example of embodiment, filter FX 50 is identified with the colour red, since the target value for the dialysis dose of 1.40 cannot be achieved with this filter. Filter FX 60 is identified with the colour yellow, since the target value for the dialysis dose can only be achieved with this filter with a rela-tively high dialysing fluid flow amounting to more than 1.5 times the blood flow. Filters FX 80 and FX 100, on the other hand, are identified with the colour green, since the target value for the dialysis dose can be achieved with a relatively low dialysing fluid flow with these filters. It can be seen in the present example of embodiment that the sum of the costs, which consist of the filter prices and the other costs, which include costs for perme-ate, acid, bicarbonate and electricity, is minimal with filter FX 100.
Following a compari-son of the various total costs, computing unit 24A therefore selects dialyser FX 100 with which the total cost is minimal. The result is displayed in the main menu (fig. 2: Qb 290, filter FX 100 Qd 500).
Fig. 4 shows the sub-menu for the alternative higher blood flow of 320 ml/min (Qb 2).
With the raised blood flow, it can be seen that filter FX 50 no longer comes into considera-tion. This filter is therefore no longer displayed in the mask. With the raised blood flow, the target value for dialysis dose KtN can already be achieved with a dialysing fluid flow of 400 ml/min when filter FX 100 is used. The total cost of the treatment is also lowest with this filter. Consequently, the computing unit again suggests filter FX
100 also for the treatment with the higher blood flow of 320 ml/min (fig. 2: Qb 320, filter FX
100 Qd 400).
It is now left to the doctor's discretion whether he performs the treatment with filter FX
100 with the lower or higher blood flow at the higher or lower dialysing fluid flow. The example of embodiment thus shows that the device according to the invention makes it particularly clear to the doctor what the effects will be of changing the blood flow or the treatment time.
Figures 5 to 7 show the main menu and the two sub-menus, which are displayed on display unit 24D of the device according to the invention for optimising the blood treatment, when it is not an HD treatment, but an HDF treatment (haemodiafiltration) with post-dilution (HDFPost) that is preselected. The treatment parameters are otherwise identical to the pa-rameters with which the treatment is carried out in the first example of embodiment.
In the main menu (fig. 5), filter FX 100 with a dialysing fluid flow of 300 ml/min is sug-gested for blood flow Qb 290 ml/min and filter FX 80 for a blood flow Qb of 320 ml/min also with a dialysing fluid flow of 300 ml/min, in order to keep the cost of the treatment as low as possible without abandoning the target value for the dialysis dose.
The sub-menu for blood flow Qb of 290 ml/min (fig. 6) shows that a treatment is in princi-ple possible with filters FX 60 to FX 100. For these filters, the computing unit calculates a dialysing fluid flow which lies between 600 and 300 ml/min. The target value of the di-alysis dose of 1.40 can be achieved with all the filters. The total cost of the treatment, however, is lowest with filter FX 100. The dialysing fluid flow is also lowest with filter FX 100. The effect of an increase in the blood flow to 320 ml/min is that the total cost of the treatment is lowest with filter FX 80 (fig. 7). The dialysing fluid flow is also lowest with filter FX 80. This corresponds to the dialysing fluid flow with filter FX
100 with the lowest blood flow.
Making reference to figures 8 to 11, the case is described where the therapeutic aim cannot be achieved even within the preselected tolerance for dialysis dose KTN.
Fig. 8 shows display screen 24D, on which the preselected value for dialysis dose KTN is displayed. The doctor has preselected a dialysis dose KTN of 1.4. If the therapeutic aim is not achieved for example with low blood flow Qb or large distribution volume V, the doctor receives an indication. In the present example of embodiment, the achievable value for dialysis dose KTN of 1.24, which lies below the preselected value of 1.4, i.e. also lies outside the preselected tolerance of 2%, is displayed on a red background.
This thus sig-nals that the therapeutic aim is not achieved.
In this case, the largest dialyser and the highest dialysing fluid flow Qd would always have to be selected in order to come as close as possible to the target value.
Effective use of the means, however, is not therefore present.
Computing unit 24A in this case automatically performs a further optimisation step, in which the value for dialysis dose KTN, for example 1.24, reached in the first optimisation step is preselected as the new target value. Computing unit 24A again takes a preselected tolerance, for example 2%, into account for the new target value.
Fig. 9 shows display screen 24D, on which the result of the calculation in the second opti-misation step is displayed with a target value for dialysis dose KTN of 1.24.
It can be seen that a dialysis dose KTN of 1.22 results, which again lies outside the preselected tol-erance, but is only slightly less than the preselected target value of 1.24.
Since the newly calculated value for dialysis dose KTN again lies outside the tolerance, the value is again displayed on a red background. Computing unit 24A calculates the cost that is incurred with the preselected parameters that are displayed on display screen 24D. In the present example of embodiment, the cost amounts to EUR 21.30.
Figures 10 and 11 show that an increase in dialysis dose KTN to 1.4 can be achieved with an increase in blood flow Qb and/or treatment time T. For example, a dialysis dose KTN
of 1.39, which lies within the tolerance, can be achieved by the fact that blood flow Qb is increased from 300 to 350 ml/min with an identical treatment time T of 240 min (fig. 10).
A dialysis dose KTN of 1.39 can however also be achieved with a blood now Qb of 320 ml/min with a treatment time T of 255 (fig. 11.). Computing unit 24A
calculates the cost for the various preselections which amounts to EUR 21.42 (fig. 10) and EUR
22.22 (fig.
11), so that the doctor can make a decision as to the parameters with which the treatment should be carried out.
The device according to the invention for optimising the blood treatment, which can form an independent unit or be a component of the extracorporeal blood treatment apparatus, will be described below. When the device for optimising the blood treatment is a compo-nent of the blood treatment apparatus, the device for optimising the blood treatment can make use of the components which are already present in the blood treatment apparatus.
For example, the device for optimising the blood treatment can make use of central com-puting and memory unit 17.
In the present example of embodiment, device 24 for optimising the blood treatment com-prises its own computing unit 24A, its own memory unit 24B and a separate input unit 24C
and separate display unit 24D, which are connected to one another via data lines 24E. De-vice 24 is connected via a further data line 23 to central computing and control unit 17.
Computing and memory unit 24A, 24B can form part of a central data processing system on which a data processing program runs, wherein input unit 24C can be a keyboard and display unit 24D a display screen.
Fig. 2 shows display screen 24D of the device according to the invention. The display screen displays the treatment parameters which are inputted by the doctor in charge on input unit 24C or which are calculated by computing unit 24A. The parameters are dis-played on the display screen with the aid of masks 25.
In the present example of embodiment, the doctor in charge first preselects the patient-specific treatment parameters which are characteristic of the therapeutic aim and the pa-tient to be treated. The treatment parameters characteristic of the therapeutic aim are dis-played on the display screen in input mask 25 in first line 25A, whilst the parameters char-acteristic of the patient are displayed in line 25B. The therapeutic aim is preselected by the doctor with the treatment parameters of dialysis dose Kt/V, treatment duration T and the treatment method: haemodialysis HD, haemodiafiltration HDF with post-dilution HDFPOSt or pre-dilution HDFpre. The doctor preselects for the patient a specific blood flow Qb, a specific urea distribution volume V and various other laboratory data, which can include for example haematocrit HKT. A tolerated deviation from the target value can be prese-lected for dialysis dose KtN.
In the present example of embodiment, 1.4 is preselected for dialysis dose Kt/V, 240 min for treatment time T, haemodialysis HD for the treatment method, 290 ml/min for blood flow Qb and 35 I for urea distribution volume V. Furthermore, 2% is preselected as the tolerated deviation from the target value for dialysis dose Kt/V.
Furthermore, the doctor can preselect whether high-flux dialysers or filters or low-flux dialysers or filters should preferably be used. The doctor can also preselect the type of blood treatment apparatus. This is set in column 25C of mask 25. Here, the doctor has preselected high-flux dialysers or filters and selected a dialysis machine of type 5008, which can be displayed by colour background of the individual fields. In order to prompt the doctor to consider an increase in the blood flow, a further value for the blood flow can be inputted which is greater than the first value. The subsequent calculation then takes place for the lower and the higher blood flow. Here, the doctor has inputted 320 ml/min for increased blood flow Qb. Both blood flows are displayed in column 25D.
Since an increase in the dialysing fluid flow above a preselected upper threshold value does not lead in practice to a significant increase in clearance K, an upper threshold value can be preselected for the dialysing fluid flow. In the case of patients with a small distri-bution volume V, it may happen that the target value for dialysis dose Kt/V is already rea-ched with a dialysing fluid flow that is smaller than the blood flow. In such cases, a dial-ysing fluid flow can be preselected that is equal to the blood flow. A
preselected lower threshold value can also be preselected for the dialysing fluid flow. The preselection of upper and lower threshold values for the dialysing fluid flow or blood flow is however only an option.
Device 24 according to the invention for optimising the blood treatment now determines, both for the preselected lower blood flow and the higher blood flow of 290 and ml/min respectively, the type of dialyser or filter with which the cost of the dialysis treat-ment is minimal with a specific dialysing fluid flow Qd. In the present example of em-bodiment, the device suggests, for optimisation of the blood treatment, a filter of type FX
100 with a dialysing fluid flow Qd of 500 ml/min when blood flow Qb is 290 ml/min.
When blood flow Qb is 320 ml/min, the device also suggests a filter of type FX
100, dial-ysing fluid flow Qd however being 400 ml/min. The way in which the data are evaluated is described in detail below.
In memory unit 24B, a specific blood flow range Qbl to Qb2 is assigned in each case to different dialysers or filters from a group of dialysers or filters. The group of dialysers or filters comprises two kinds of filters, which include the high-flux filters and the low-flux filters. The high-flux filters for example include the type series FX 50, FX
60, FX 80 and FX 100.
On the basis of the type of dialyser or filter selected by the doctor, for example a high-flux filter, and desired blood flow Qb, those filters are selected from the respective type series that are in principle suitable for desired blood flow Qb.
Example 1: Selected FX high-flux, Qb = 220 ml/min : FX 50 to FX 100 are possible.
Example 2: Selected FX high-flux, Qb = 370 ml/min : FX 60 to FX 100 are possible.
From the preselected value for dialysis dose KTN, for example 1.40, inputted treatment time T and inputted urea distribution volume V, computing unit 24A next calculates a tar-get value for clearance K. When the target value for clearance K is calculated, the prese-lected tolerance, for example 2%, is taken into account in the preselected target value for dialysis dose KTN, so that a value for dialysis dose KT/V within the preselected tolerance can be accepted in the subsequent calculation of the cost of the treatment. In individual cases, cost savings can thus be made without this having demonstrable effects on the suc-cess of the treatment in practice.
When the target value for clearance K is determined, computing unit 24A
calculates, for all the dialysers or filters that have been determined beforehand, dialysing fluid flow Qd required in each case for the treatment, taking account of the preselected treatment method, for example HD, HDFP0St, HDFpie, preselected blood flow Qb and other parameters, which include for example haematocrit HKT. From previously determined clearance K
and pre-selected blood flow Qb, the computing unit calculates dialysing fluid flow Qd that is re-quired to achieve desired clearance K. The calculation of required dialysing fluid flow Qd is carried out for an HD treatment with coefficient kOA on the basis of the following equa-tion:
1-exp -kOAQd -Qb K=QbQd Qd Qb eR kOA Qd - Qb Qd - Qb p Qd Qb For other types of treatment, such as for example HDF, other equations can be used to cal-culate K. Coefficient kOA is a magnitude characteristic of the given dialyser or filter, which is essentially dependent on the active surface of the semipermeable membrane of the dialyser or filter and its diffusion resistance.
Stored in memory unit 24B for all dialysers or filters are the respective coefficients kOA, which are read out from the memory by computing unit 24A in order to calculate dialysing fluid rate Qd. The aforementioned method for determining the dialysing fluid rate is de-scribed in detail in WO 2007/140993 Al, to the disclosure whereof reference is expressly made. For the invention, however, the method by which the dialysing fluid rate is deter-mined is ultimately irrelevant.
Furthermore, the costs of various consumables and the energy costs are stored in memory unit 24B. All the necessary costs (selling prices) can be inputted using appropriate menus.
In the present example of embodiment, the costs of the consumables include the costs for permeate, acid and bicarbonate and the energy costs include the costs for electricity. The costs (selling prices) of the individual dialysers or filters are also stored in memory unit 24B.
For all the dialysers or filters which are suggested for the blood treatment, computing unit 24B calculates the quantity of the given consumables (permeate, acid, bicarbonate) and the quantity of energy (electricity) that is consumed in the blood treatment, taking account of given dialysing fluid rates Qd and preselected blood flow rates Qb.
From the calculated quantity of consumables and the stored costs of consumables as well as the consumed energy and the energy costs, computing unit 24A now calculates the costs for all the consumables and the costs for the energy consumed in the treatment. Finally, the computing unit calculates the total costs for all types of dialysers or filters in each case from the sum of the previously determined costs for the consumables consumed in the treatment and the costs for the consumed energy as well as the costs of the dialysers or filters.
The final selection of the dialyser or filter is then made on the premise that the total cost is minimal.
Via the menu item "costs", the doctor can call up a sub-menu in which the individual costs for the suggested dialysers or filters are shown. Fig. 3 shows the sub-menu for the present example of embodiment, in which blood flow Qb of 290 ml/min (Qb 1) is preselected (fig.
2).
In the cost presentation, all the dialysers or filters which are suitable for the intended blood flow are always displayed in columns. In the present example of embodiment, in which a blood flow of 290 ml/min is preselected, these are the high-flux dialysers FX
50 to FX
100. A colour background of the menu items is used to identify those dialysers or filters with which the target value for dialysis dose KtN cannot be achieved, with which the tar-get value for the dialysis dose can only be achieved with a relatively high dialysing fluid flow or with a relatively low dialysing fluid flow. In the present example of embodiment, filter FX 50 is identified with the colour red, since the target value for the dialysis dose of 1.40 cannot be achieved with this filter. Filter FX 60 is identified with the colour yellow, since the target value for the dialysis dose can only be achieved with this filter with a rela-tively high dialysing fluid flow amounting to more than 1.5 times the blood flow. Filters FX 80 and FX 100, on the other hand, are identified with the colour green, since the target value for the dialysis dose can be achieved with a relatively low dialysing fluid flow with these filters. It can be seen in the present example of embodiment that the sum of the costs, which consist of the filter prices and the other costs, which include costs for perme-ate, acid, bicarbonate and electricity, is minimal with filter FX 100.
Following a compari-son of the various total costs, computing unit 24A therefore selects dialyser FX 100 with which the total cost is minimal. The result is displayed in the main menu (fig. 2: Qb 290, filter FX 100 Qd 500).
Fig. 4 shows the sub-menu for the alternative higher blood flow of 320 ml/min (Qb 2).
With the raised blood flow, it can be seen that filter FX 50 no longer comes into considera-tion. This filter is therefore no longer displayed in the mask. With the raised blood flow, the target value for dialysis dose KtN can already be achieved with a dialysing fluid flow of 400 ml/min when filter FX 100 is used. The total cost of the treatment is also lowest with this filter. Consequently, the computing unit again suggests filter FX
100 also for the treatment with the higher blood flow of 320 ml/min (fig. 2: Qb 320, filter FX
100 Qd 400).
It is now left to the doctor's discretion whether he performs the treatment with filter FX
100 with the lower or higher blood flow at the higher or lower dialysing fluid flow. The example of embodiment thus shows that the device according to the invention makes it particularly clear to the doctor what the effects will be of changing the blood flow or the treatment time.
Figures 5 to 7 show the main menu and the two sub-menus, which are displayed on display unit 24D of the device according to the invention for optimising the blood treatment, when it is not an HD treatment, but an HDF treatment (haemodiafiltration) with post-dilution (HDFPost) that is preselected. The treatment parameters are otherwise identical to the pa-rameters with which the treatment is carried out in the first example of embodiment.
In the main menu (fig. 5), filter FX 100 with a dialysing fluid flow of 300 ml/min is sug-gested for blood flow Qb 290 ml/min and filter FX 80 for a blood flow Qb of 320 ml/min also with a dialysing fluid flow of 300 ml/min, in order to keep the cost of the treatment as low as possible without abandoning the target value for the dialysis dose.
The sub-menu for blood flow Qb of 290 ml/min (fig. 6) shows that a treatment is in princi-ple possible with filters FX 60 to FX 100. For these filters, the computing unit calculates a dialysing fluid flow which lies between 600 and 300 ml/min. The target value of the di-alysis dose of 1.40 can be achieved with all the filters. The total cost of the treatment, however, is lowest with filter FX 100. The dialysing fluid flow is also lowest with filter FX 100. The effect of an increase in the blood flow to 320 ml/min is that the total cost of the treatment is lowest with filter FX 80 (fig. 7). The dialysing fluid flow is also lowest with filter FX 80. This corresponds to the dialysing fluid flow with filter FX
100 with the lowest blood flow.
Making reference to figures 8 to 11, the case is described where the therapeutic aim cannot be achieved even within the preselected tolerance for dialysis dose KTN.
Fig. 8 shows display screen 24D, on which the preselected value for dialysis dose KTN is displayed. The doctor has preselected a dialysis dose KTN of 1.4. If the therapeutic aim is not achieved for example with low blood flow Qb or large distribution volume V, the doctor receives an indication. In the present example of embodiment, the achievable value for dialysis dose KTN of 1.24, which lies below the preselected value of 1.4, i.e. also lies outside the preselected tolerance of 2%, is displayed on a red background.
This thus sig-nals that the therapeutic aim is not achieved.
In this case, the largest dialyser and the highest dialysing fluid flow Qd would always have to be selected in order to come as close as possible to the target value.
Effective use of the means, however, is not therefore present.
Computing unit 24A in this case automatically performs a further optimisation step, in which the value for dialysis dose KTN, for example 1.24, reached in the first optimisation step is preselected as the new target value. Computing unit 24A again takes a preselected tolerance, for example 2%, into account for the new target value.
Fig. 9 shows display screen 24D, on which the result of the calculation in the second opti-misation step is displayed with a target value for dialysis dose KTN of 1.24.
It can be seen that a dialysis dose KTN of 1.22 results, which again lies outside the preselected tol-erance, but is only slightly less than the preselected target value of 1.24.
Since the newly calculated value for dialysis dose KTN again lies outside the tolerance, the value is again displayed on a red background. Computing unit 24A calculates the cost that is incurred with the preselected parameters that are displayed on display screen 24D. In the present example of embodiment, the cost amounts to EUR 21.30.
Figures 10 and 11 show that an increase in dialysis dose KTN to 1.4 can be achieved with an increase in blood flow Qb and/or treatment time T. For example, a dialysis dose KTN
of 1.39, which lies within the tolerance, can be achieved by the fact that blood flow Qb is increased from 300 to 350 ml/min with an identical treatment time T of 240 min (fig. 10).
A dialysis dose KTN of 1.39 can however also be achieved with a blood now Qb of 320 ml/min with a treatment time T of 255 (fig. 11.). Computing unit 24A
calculates the cost for the various preselections which amounts to EUR 21.42 (fig. 10) and EUR
22.22 (fig.
11), so that the doctor can make a decision as to the parameters with which the treatment should be carried out.
Claims (14)
- Claims A method for optimising an extracorporeal blood treatment with an extracorporeal blood treatment apparatus, which comprises a dialyser or filter divided by a semipermeable membrane into a first chamber and a second chamber, wherein the first chamber is part of an extracorporeal blood circuit and the second chamber of the dialyser or filter is part of a dialysing fluid system, with the following process steps:
inputting one or more patient-specific treatment parameters on an input unit, which are characteristic of the therapeutic aim and/or the patient to be treated, determining for all types of dialyser or filter, by means of a computing unit, a ma-chine-specific treatment parameter from the one or from the plurality of patient-specific treatment parameters for performing the treatment using in each case one of the dialysers or filters from a group of different types of dialyser or filter, determining for all types of dialyser or filter, by means of the computing unit, the cost of the extracorporeal blood treatment resulting from the ascertained machine-specific treatment parameter using the given dialyser or filter, displaying the cost resulting from the machine-specific treatment parameter using the given dialyser or filter on a display unit for all types of dialyser or filter. - 2. The method according to claim 1, characterised in that the step of determining the cost of the extracorporeal blood treatment comprises the following steps:
storing the costs of the various types of dialyser or filter in a memory unit, storing the costs of consumables and/or the energy costs in the memory unit, calculating in the computing unit the quantity of the respective consumables and/or the quantity of energy that is consumed in the performance of the extracorporeal blood treatment with the ascertained machine-specific treatment parameter, calculating the costs of the consumables and/or energy consumed in the extracorpo-real blood treatment from the costs of the consumables and/or energy costs on the one hand and the calculated quantity of consumables and/or energy on the other hand, the total costs for all types of dialyser or filter being calculated with the computing unit in each case from the sum of the stored costs of the respective dialyser or filter and the calculated costs of the consumables and/or energy consumed in the extra-corporeal blood treatment. - 3. The method according to claim 1 or 2, characterised in that the different quantities of the machine-specific treatment parameter for the different dialysers or filters and the total cost of the extracorporeal blood treatment resulting from the use of the given dialyser or filter and the adjustment of the given machine-specific treatment parameter are displayed on the display unit.
- 4. The method according to any one of claims 1 to 3, characterised in that a machine-specific treatment parameter is the dialysing fluid flow with which dialysing fluid flows through the second chamber of the dialyser or filter.
- 5. The method according to any one of claims I to 4, characterised in that a patient-specific parameter is a parameter from the group of parameters which comprises blood distribution volume V, duration T of the extracorporeal blood treatment, the dialysis dose, clearance K or blood flow Q b in extracorporeal blood circuit I.
- 6. The method according to any one of claims I to 5, characterised in that the comput-ing unit is used to select the dialyser or filter with which the cost resulting for the treatment is lowest, and in that this dialyser or filter is displayed on the display unit.
- 7. A device for optimising an extracorporeal blood treatment with an extracorporeal blood treatment apparatus, which comprises a dialyser or filter divided by a semipermeable membrane into a first chamber and a second chamber, wherein the first chamber of the dialyser or filter is part of an extracorporeal blood circuit and the second chamber is part of a dialysing fluid system, wherein the device (24) for optimising an extracorporeal blood treatment com-prises:
an input unit (24C) for inputting one or more patient-specific treatment parameters, which are characteristic of the therapeutic aim and/or the patient to be treated, a computing unit (24A), which is designed in such a way that a machine-specific treatment parameter can be determined, for all types of dialyser or filter, from the one or more patient-specific treatment parame-ters for performing the treatment using in each case one of the dialysers or filters from a group of different types of dialyser or filter and that cost of the extracorporeal blood treatment resulting from the machine-specific treatment parameter using the given dialyser or filter can be deter-mined for all types of dialyser or filter, and a display unit (24D) for displaying, for all types of dialyser or filter, the cost resulting from the machine-specific treatment parameter using the given dialyser or filter. - 8. The device according to claim 7, characterised in that the device (24) comprises a memory unit (24B) for storing the costs of the various types of dialyser or filter and the costs of consumables and/or the energy costs, and the computing unit (24A) is designed in such a way that the quantity of the given consumables and/or the quantity of energy is calcu-lated that is consumed in the performance of the extracorporeal blood treatment with a specific quantity of the machine-specific treatment parameter, that the costs of the consumables and/or energy consumed in the extracorporeal blood treatment are calculated from the costs of the consumables and/or energy costs on the one hand and the calculated quantity of consumables and/or energy on the other hand, and that the total costs for all types of dialyser or filter are calculated in each case from the sum of the stored costs of the respective dialyser or filter and the calculated costs of the consumables and/or energy consumed in the extracorporeal blood treatment.
- 9. The device according to claim 7 or 8, characterised in that the display unit (24D) comprises different fields, in which the different quantities of the machine-specific treatment parameter for the different dialysers or filters and the total cost of the ex-tracorporeal blood treatment resulting from the use of the given dialyser or filter and the adjustment of the given machine-specific treatment parameter are dis-played.
- 10. The device according to any one of claims 7 to 9, characterised in that a machine-specific treatment parameter is the dialysing fluid flow with which dialysing fluid flows through the second chamber of the dialyser or filter.
- 11. The device according to any one of claims 7 to 10, characterised in that the com-puting unit (24A) is designed in such a way that the dialyser or filter is selected with which the cost resulting for the treatment is lowest, and in that the display unit (24D) is designed in such a way that this dialyser or filter is displayed.
- 12. The device according to any one of claims 7 to 11, characterised in that a patient-specific parameter is a parameter from the group of parameters comprising blood distribution volume V, duration T of the extracorporeal blood treatment, the dialy-sis dose, clearance K or blood flow Q b in extracorporeal blood circuit I.
- 13. An extracorporeal blood treatment apparatus, which comprises a dialyser (1) or filter divided by a semipermeable membrane (2) into a first chamber (3) and a sec-ond chamber (4), wherein the first chamber (3) is part of an extracorporeal blood circuit (I) and the second chamber (4) of the dialyser (1) or filter is part of a dialys-ing fluid system (II), characterised in that the extracorporeal blood treatment appa-ratus comprises a device for optimising the extracorporeal blood treatment accord-ing to any one of claims 7 to 12.
- 14. A computer program product to be run on a data processing device for performing the method for optimising an extracorporeal blood treatment apparatus according to any one of claims 1 to 6.
Applications Claiming Priority (3)
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|---|---|---|---|
| DE102009021255.8 | 2009-05-14 | ||
| DE102009021255A DE102009021255A1 (en) | 2009-05-14 | 2009-05-14 | Method and device for optimizing extracorporeal blood treatment |
| PCT/EP2010/002945 WO2010130449A1 (en) | 2009-05-14 | 2010-05-12 | Method and apparatus for optimizing an extracorporeal blood treatment |
Publications (2)
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| CA2759937A1 true CA2759937A1 (en) | 2010-11-18 |
| CA2759937C CA2759937C (en) | 2018-06-05 |
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| CA2759937A Active CA2759937C (en) | 2009-05-14 | 2010-05-12 | Method and apparatus for optimising an extracorporeal blood treatment |
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| EP (1) | EP2429606B1 (en) |
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| WO (1) | WO2010130449A1 (en) |
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| JP5359822B2 (en) * | 2009-11-30 | 2013-12-04 | ニプロ株式会社 | Hemodialysis machine |
| NZ609581A (en) | 2010-09-20 | 2014-10-31 | Gambro Lundia Ab | Obtaining control settings for a dialysis machine |
| DE102012017432A1 (en) * | 2012-09-04 | 2014-03-06 | Fresenius Medical Care Deutschland Gmbh | Apparatus for quantifying and displaying a time buffer of a patient. Blood treatment device and method |
| EP3528260A1 (en) * | 2013-11-18 | 2019-08-21 | Gambro Lundia AB | Dialysis apparatus with versatile user interface and method and computer program therefor |
| DE102014104768A1 (en) * | 2014-04-03 | 2015-10-29 | B. Braun Avitum Ag | Apparatus and method for determining a distribution volume in a dialysis patient |
| DE102014013229A1 (en) * | 2014-09-05 | 2016-03-10 | Fresenius Medical Care Deutschland Gmbh | Apparatus for performing a tidal peritoneal dialysis treatment |
| CN107545203A (en) * | 2016-06-28 | 2018-01-05 | 学透通医疗科技（上海）有限公司 | Hemo system identifying system and its information processing method based on bar code identification |
| EP3511033A4 (en) | 2016-09-08 | 2020-04-22 | Kabushiki Kaisya Advance | System for managing information relating to differences between individuals in dialysis treatment |
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| DE3909967A1 (en) * | 1989-03-25 | 1990-09-27 | Fresenius Ag | HAEMODIALYSIS DEVICE WITH AUTOMATIC ADJUSTMENT OF THE DIALYSIS FLUID FLOW |
| US5319542A (en) * | 1990-09-27 | 1994-06-07 | International Business Machines Corporation | System for ordering items using an electronic catalogue |
| US5515524A (en) | 1993-03-29 | 1996-05-07 | Trilogy Development Group | Method and apparatus for configuring systems |
| US5308315A (en) * | 1993-07-27 | 1994-05-03 | Raja N. Khuri | Method for determining the adequacy of dialysis |
| US5609770A (en) * | 1995-06-07 | 1997-03-11 | Cobe Laboratories, Inc. | Graphical operator machine interface and method for information entry and selection in a dialysis machine |
| JP3254123B2 (en) * | 1996-02-14 | 2002-02-04 | テルモ株式会社 | Blood circuit design equipment |
| US6187199B1 (en) * | 1997-01-24 | 2001-02-13 | Fresenius Medical Care Deutschland Gmbh | Process and device for determining hemodialysis parameters |
| US6117100A (en) * | 1997-06-06 | 2000-09-12 | Powers; Kathleen M. | Hemodialysis-double dialyzers in parallel |
| EP1927370B1 (en) * | 1997-08-13 | 2013-10-02 | Fresenius Medical Care Deutschland GmbH | Method for setting parameters for hemodialysis and blood processing device with a device for setting parameters for hemodialysis |
| JP3491675B2 (en) * | 1999-03-04 | 2004-01-26 | 株式会社ジェイ・エム・エス | Method for determining blood circuit configuration for dialysis |
| FR2801794B1 (en) * | 1999-12-02 | 2002-01-11 | Hospal Ag | METHOD FOR DETERMINING A SIGNIFICANT PARAMETER OF THE PROGRESS OF AN EXTRACORPOREAL BLOOD TREATMENT |
| JP3491684B2 (en) * | 2000-06-01 | 2004-01-26 | 株式会社ジェイ・エム・エス | Medical blood circuit configuration determination method and configuration determination system |
| US20030083901A1 (en) * | 2001-06-22 | 2003-05-01 | Bosch Juan P. | Process for providing dialysis and other treatments |
| DE102004011264B4 (en) * | 2003-03-11 | 2014-03-27 | B. Braun Medizintechnologie Gmbh | dialysis Center |
| JP4408644B2 (en) * | 2003-03-24 | 2010-02-03 | フレゼニウス メディカル ケア ドイッチェランド ゲゼルシャフト ミット ベシュレンクテル ハフツング | Blood filtration device |
| JP4379027B2 (en) * | 2003-05-14 | 2009-12-09 | 株式会社ジェイ・エム・エス | Peritoneal dialysis and hemodialysis combined planning method and peritoneal dialysis and hemodialysis combined planning device |
| ITMO20040191A1 (en) * | 2004-07-23 | 2004-10-23 | Gambro Lundia Ab | MACHINE AND METHOD FOR EXTRA-BODY BLOOD TREATMENT. |
| EP2023972B1 (en) | 2006-06-08 | 2015-04-01 | Fresenius Medical Care Deutschland GmbH | Device and method for controlling an extracorporeal blood treatment device |
| DE102006045437A1 (en) * | 2006-09-26 | 2008-04-03 | Fresenius Medical Care Deutschland Gmbh | Apparatus and method for prescribing a dialysis fluid rate or blood flow rate for extracorporeal blood treatment |
| US7981281B2 (en) * | 2008-07-09 | 2011-07-19 | Baxter International, Inc. | Dialysis system having regimen generation methodology |
| US8168063B2 (en) * | 2008-07-09 | 2012-05-01 | Baxter International Inc. | Dialysis system having filtering method for determining therapy prescriptions |
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| AU2010247705B2 (en) | 2015-04-09 |
| WO2010130449A1 (en) | 2010-11-18 |
| US20120078658A1 (en) | 2012-03-29 |
| EA032893B1 (en) | 2019-07-31 |
| BRPI1014264B8 (en) | 2021-06-22 |
| BRPI1014264A2 (en) | 2016-04-12 |
| ES2421756T3 (en) | 2013-09-05 |
| PT2429606E (en) | 2013-06-28 |
| US9878082B2 (en) | 2018-01-30 |
| EP2429606A1 (en) | 2012-03-21 |
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